Form Cat 1 - Commercial Activity Tax Registration Page 4

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CAT 1
Schedule B
Rev. 5/11
P.O. Box 16158
Columbus, OH 43216-6158
tax.ohio.gov
Schedule B – Commercial Activity Tax (CAT)
Members of Consolidated Elected Taxpayers or Combined Taxpayer
A consolidated election will remain in effect for eight calendar quarters and is automatically renewable unless cancelled by the registrant
or revoked by the tax commissioner. Please complete the information below for each member of the consolidated elected or combined group.
Primary entity of consolidated or combined group:
(as shown on line 4)
CAT account no. (if issued) of primary
FEIN:
SSN:
entity of consolidated or combined group:
Type of organization
1
Federal Employer ID No.
Social Security No.
Address
State of organization
Name of Member of Consolidated Elected Taxpayer or Combined Taxpayer
City
State
ZIP code
NAICS code
2
Country of organization
Trade name or DBA
Country
I hereby declare the above to be true and correct to the best of my knowledge and belief.
Date (MM/DD/YY)
Signature of applicant or agent
1
Organization type (association/trust, C corporation, LLC, LLP, LTD (non-U.S.), partnership, S corporation, sole proprietorship, other)
Please make additional copies
2
For NAICS codes visit tax.ohio.gov
of this schedule as necessary.

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